AB083. 230. A review of the treatments for otomycosis

Background: The incidence of fungal otitis externa, also known as otomycosis, has increased in Western Europe over the past number of decades. Clinically, it presents like otitis media, cholesteatoma, and chronic suppurative otitis media (CSOM), therefore it is often misdiagnosed and treated inappropriately. Aspergillus and Candida are shown to be the commonest causative species isolated in fungal otitis externa. Otomycosis is commonly diagnosed post antimicrobial therapy with no resolution. To date, there is no gold standard approach in place for the treatment of otomycosis. Several studies have shown the efficacy of topical drying agents, anti-inflammatories, antifungals, and combination powders with and without the implementation of minor procedures such as microsuction or aural toilet.

Methods: Review of the literature aimed at the different approaches and modalities used for the eradication of fungal otitis externa.

Results: Topical antifungals are effective in the eradication of Aspergillus and Candida. Clotrimazole as a monotherapy has been found to have the greatest efficacy in the treatment of fungal otitis externa. Studies have shown that combination therapies such as microsuction, or aural toilet, followed by insufflation of a compound mixture is effective in eradicating otomycosis, while also providing additional coverage against other offending pathogens.

Conclusions: Ototopical antifungals are effective in the eradication of otomycosis, with clotrimazole shown to be the most effective. However, a multimodal approach such as microsuction and insufflation of a combination powder has an increased likely hold of fungal eradication with additional antimicrobial cover.

Keywords: Otomycosis treatment review